Guideline on Platelet and Plasma Transfusion Released by CHEST
April 30, 2025
Glenview, Illinois – The American College of Chest
Physicians® (CHEST) recently released a new
clinical guideline on the transfusion of fresh frozen plasma (FFP) and platelets in critically ill adults. Published in the journal CHEST®, the guideline
contains seven evidence-based recommendations to provide a framework for
clinicians to implement in their own facilities.
“In practice, we see all too often [that] prophylactic transfusion of
platelets or fresh frozen plasma is done unnecessarily,” says Angel Coz
Yataco, MD, FCCP, lead author on the guideline. “Transfusion is rarely
needed prior to bedside procedures, with lumbar puncture being a possible
exception. Following the new guideline, we can drastically reduce the use of
FFP.”
The panel of experts developed seven Population, Intervention, Comparator,
and Outcome questions addressing platelet and FFP transfusions in critically
ill patients and performed a comprehensive evidence review. The panel
applied the Grading of Recommendations, Assessment, Development, and
Evaluations approach to assess the certainty of evidence and to formulate
and grade recommendations.
“In the United States, 20% of platelets and FFP are transfused to critically
ill patients, totaling 2.2 million units of each annually,” says Dr. Coz
Yataco. “They are scarce resources with variable costs and access globally.
If implemented on a large scale, this guideline provides the framework to
decrease the use [to] approximately half a million less units of platelets
and FFP transfused annually in the United States alone.”
The panel formulated seven conditional recommendations. In addition to four
procedure-specific recommendations, the guideline recommends:
-
In stable non-bleeding critically ill patients with thrombocytopenia and
without high risk of spontaneous bleeding, we suggest transfusing
platelets if platelet counts fall below 10 × 109/L
(Conditional recommendation, very low certainty of evidence).
-
In stable non-bleeding critically ill patients with thrombocytopenia who
are considered at high risk of spontaneous bleeding, we suggest
transfusing platelets if platelet counts fall below 30-50 × 109/L
(Conditional recommendation, very low certainty of evidence).
-
In critically ill patients with thrombocytopenia and serious active
bleeding, we suggest transfusing platelets if platelet counts fall below
50 × 109/L
(Conditional recommendation, very low certainty of evidence).
The entire list of recommendations included in the new guideline can be
accessed through the
CHEST journal website.
About the American College of Chest Physicians
The American College of Chest Physicians® (CHEST) is the global
leader in the prevention, diagnosis, and treatment of chest diseases. Its
mission is to champion advanced clinical practice, education, communication,
and research in chest medicine. It serves as an essential connection to
clinical knowledge and resources for its 22,000+ members from around the
world who provide patient care in pulmonary, critical care, and sleep
medicine. For information about the American College of Chest Physicians and
its family of journals, including the flagship journal CHEST®,
visit chestnet.org.